title: Antigen carbohydrate 125 and brain natriuretic peptide serial measurements for risk stratification following an episode of acute heart failure.
abstract: BACKGROUND
  The prognostic utility of combining serial measurements of brain natriuretic peptide (BNP) and antigen carbohydrate 125 (CA125) is largely unknown. The aim of this work is to assess the prognostic utility of serial measurements of BNP, CA125, and their optimal combination for predicting long-term mortality, following a hospitalization for acute heart failure (AHF).
  
  
  RESULTS
  We analyzed 293 consecutive patients admitted with AHF where CA125 and BNP were measured at discharge (T1) and at the first ambulatory visit (T2: median 31 days after discharge). Biomarkers were evaluated as snapshot determinations or as serial changes in absolute, relative or categorical changes and related to subsequent mortality with Cox regression analysis. The incremental prognostic value added by each biomarker was evaluated by the integrated discrimination improvement (IDI) index. During a median follow-up of 18 months, 91 deaths (31.1%) were identified. From the different metrics tested, the categorical changes in CA125 (Normalization: decreasing to≤35 U/ml at T2; Decreasing but not normalization: decreasing but T2>35 U/ml; small-increase: increasing but T2≤35 U/ml and; high-increase: increasing and T2>35 U/ml) showed the best discriminative accuracy. For BNP none of the serial changes metrics tested were superior to a single determination at T2 (BNP≥100 pg/ml). Adding these two biomarkers characterization to the clinical model, resulted in a 9.21% (p<0.001) gain in IDI index.
  
  
  CONCLUSIONS
  In patients discharged for AHF, CA125 modeled as a pre-post categorical change, and BNP as a single determination at T2, resulted in the best marker combination for predicting all-cause mortality.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Spain. yulnunez@gmail.com
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratalá
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D018394:CA-125 Antigen; D020097:Natriuretic Peptide, Brain